P41 An audit of the screening and treatment of uveitis in children with juvenile idiopathic arthritis (jia) at a paediatric tertiary centre

2018 ◽  
Vol 103 (2) ◽  
pp. e1.46-e1
Author(s):  
Aragon Cuevas Octavio ◽  
Roughley Amy ◽  
Morecroft Charles
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Primary Objective ◽  
British Society ◽  
List Type ◽  
Tertiary Care Centre ◽  
Screening Guidelines ◽  
Junior Staff ◽  
Clinical Records

AimThe primary objective of this study was to audit the centre’s and its satellite clinics’ compliance with the British Society for Paediatric and Adolescent Rheumatology (BSPAR) and the Royal College of Ophthalmology (RCO) uveitis screening guidelines. The secondary objective of the study was to compare the centre’s compliance with the treatment guidelines of JIA and uveitis, as recommended by NHS England and following results from the SYCAMORE trial.MethodThe clinical records of 54 patients recruited from the Childhood Arthritis Prospective Study (CAPS) were analysed over a six-week period. The data collected included patient demographics, JIA sub-type, date of referral and uveitis screening, presence of uveitis and treatment (if applicable), and details of medication prescribed for JIA. Information was gathered from the centre’s EPMA system and paper records, and was requested from the satellite centres if needed. The raw data was inputted into the statistical software SPSS v23 to evaluate the categorical data. Chi-squared tests were performed on the data to detect any potential correlation between various demographic variables and primary and secondary outcomes.Results92.6% (50/54) of patients were referred for uveitis screening after being diagnosed with JIA. For 3 (5.6%) patients there was no evidence of referral and for 1 (1.9%) patient the documentation was not clear. 90% (45/50) of the referred patients were screened for uveitis. For the remaining 5 (10%) patients, there was no documentation of whether screening had taken place. The compliance of ophthalmology departments with the BSPAR/RCO guidelines was poor with only 17.8% (8/45) of patients being screened within six weeks of the ophthalmology referral. 8.9% of patients (4/45) were diagnosed with uveitis and 2 of these patients received adalimumab as part of the treatment regime. The treatment for JIA was documented for 75.9% (41/54) of patients and all treatments (100%) were in line with the current recommendations from NHS England. Statistical correlations could not be identified due to the low numbers of patients.ConclusionThe BSPAR/RCO guidelines suggest that all new patients are to be screened as soon as possible, no longer than 6 weeks after referral.1 As uveitis is commonly an asymptomatic condition2 with severe complications such as blindness,3 routine screening is imperative. Overall, the compliance of the tertiary care centre and satellite clinics with the BSPAR/RCO guidelines was poor. Immediate changes are required to improve patient care, focusing on facilitating sharing of documentation and communication between the primary centre and its satellite clinics. Raising awareness of targets recommended by BSPAR/RCO to emphasise the importance of timely uveitis screening via regional training days should take place. Ensuring all junior staff that might see JIA patients in clinic are aware of the need of uveitis screening via offering structured training during their rotation is recommended.ReferencesBSPAR: Guidelines for Screening for Uveitis in Juvenile Idiopathic Arthritis (JIA) (1st ed.)6 Oct 2016.Engelhard SB, Asima B, Ashvini RK. Causes of uveitis in children without juvenile idiopathic arthritis. Clinical Ophthalmology2015;9:1121–1128.Juvenile Idiopathic Arthritis (JIA). Cincinnatichildrens.org. N.p., 5 Oct 2016.

scholarly journals Medications for Anxiety: A Drug utilization study in Psychiatry Inpatients from a Tertiary Care Centre of Western Nepal

1970 ◽  
Vol 1 (4) ◽  
pp. 119-125 ◽  
Author(s):  
Indrajit Banerjee ◽  
Bedanta Roy ◽  
Brijesh Sathian ◽  
Indraneel Banerjee ◽  
Sai Sailesh Kumar ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Physical Dependence ◽  
Tertiary Care ◽  
Psychiatric Inpatient ◽  
Common Disease ◽  
Utilization Pattern ◽  
Tertiary Care Centre ◽  
Prescribing Pattern ◽  
Study Results ◽  
Anxiolytic Drugs

Background   Anxiety is the most widespread psychiatric disorder and generalized anxiety disorder is the most common disease seen in the primary care setting. Currently there are a number of anxiolytic drugs commercially available in the market for treatment of these disorders such as Benzodiazepines like Diazepam, Chlordiazepoxide, Alprazolam, Betablockers like Propranolol and H1 Antihistaminics like Hydroxyzine. Some of the newer anxiolytics like Buspirone in Azapirone group is marketed as better anxiolytic drug than the traditional drugs.  Buspirone is promoted as a better drug for anxiety, as it does not cause any sedation, tolerance or physical dependence. A need for study further increases as there is no sufficient data on utilization pattern of anxiolytics on Nepalese population. This is the first study done in the utilization pattern of anxiolytic drugs in inpatient in Nepal.  Methods This is an observational study undertaken between 1st October 2009 and 31st March 2010 at the Psychiatric inpatient Department of Manipal Teaching Hospital. The prescribing pattern of Anxiolytic drugs was measured. Out of a total of 240 cases who were admitted to psychiatry inpatient ward, 38 cases have received Anxiolytic drugs. Those who were critically ill with anxiety were included in the study.  Results Out of 240 cases who were admitted to psychiatry inpatient, 130 were male patients (54.2%), 95% CI [47.9,60.5] and the rest were female patients (45.8%), CI [39.5,52.1] . In 38 cases of anxiety, the age of the patient <40 years 89.5% and >40 years 10.5%. Anxiety was more common in females 71.1% than in males 28.9%. 68.4% of the patients were unemployed whereas only 31.6% of the patients were employed. 78.9% of the drugs were prescribed by trade name. Among the anxiolytics, the commonest drug prescribed was Alprazolam (50%), followed by Clonazepam (31.6%), Chlordiazepoxide (15.8%) and Lorazepam (2.6%). Conclusion Utilization patterns of drugs for anxiolytics were according to treatment guidelines and suggested a trend towards the use of shorter acting Benzodiazepines such as Alprazolam. Continuous and prolonged use of longer acting Benzodiazepines has resulted in dependence and may have withdrawal symptoms when the dosage of these drugs is reduced or treatment is stopped.http://dx.doi.org/10.3126/nje.v1i4.5753 Nepal Journal of Epidemiology 2011;1(4):119-125

Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children

2020 ◽  
Author(s):  
Eimear McGovern ◽  
Christine Voss ◽  
Nicole M Hemphill ◽  
Shubhayan Sanatani ◽  
Vilte Barakauskas ◽  
...  
Keyword(s):  
Predictive Value ◽  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Healthy Children ◽  
Clinical Predictors ◽  
Tertiary Care Centre

Abstract Objectives Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin I for the detection of acute myocardial dysfunction in previously healthy children. Our secondary objective was to identify clinical predictors of myocardial dysfunction in the setting of elevated troponin. Study Design This was a retrospective chart review in a single, paediatric, tertiary care centre of troponin tests performed in all admitted children over a 4-year period. Demographics, symptoms, signs, chest x-ray, ECG, and echocardiogram abnormalities were documented. Myocardial dysfunction was presumed to be absent when the patient had a normal cardiac assessment, with or without echocardiography, and did not re-present. Results From January 2014 through December 2017, 566 patients had troponin tested as a screen for myocardial injury. Troponin was positive in 38 of 566 cases (6.7%). Myocardial dysfunction was detected in 9 of 566 cases (1.6%). Troponin was elevated in six of nine cases of myocardial dysfunction. The sensitivity of conventional troponin I for detecting acute myocardial dysfunction was 66% (95% confidence interval [CI] 30 to 93%). The specificity was 94% (95% CI 92 to 96%). PPV was 16% (95% CI 6 to 31%) and NPV 99% (95% CI 98 to 100%). An abnormal ECG was more prevalent in patients with a true positive versus a false-positive troponin result (P=0.03). Conclusion Troponin testing identified few cases of myocardial dysfunction. We found the test to have only 66% sensitivity. Troponin testing as a screen for myocardial injury in children has limited utility.

Utility of the Edmonton Frail Scale (EFS) in identifying frail elderly patients during treatment of colorectal cancer (CRC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14001-e14001
Author(s):  
Brandon M Meyers ◽  
Radhika Yelamanchili ◽  
Sara Rask ◽  
Humaid Obaid Al-Shamsi ◽  
Callista Maria Phillips ◽  
...  
Keyword(s):  
Pilot Study ◽  
Odds Ratio ◽  
Performance Status ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Primary Objective ◽  
Stage Ii ◽  
Care Utilization ◽  
Study Phase ◽  
Tertiary Care Centre

e14001 Background: CRC is the second leading cause of cancer-related death, and 40-50% of patients are older than 70 years. Frailty is a concept that has been proposed by geriatricians as an indicator of functional age. The EFS is a 15 point incremental scale; it is quick (<5 min), and simple to administer. We conducted a pilot study to establish if the EFS would add utility beyond clinician’s expertise. The primary objective was to determine if there was an association between the EFS and receipt of chemotherapy. Methods: The EFS was administered to stage II-IV CRC patients ≥70 years, referred to a Medical Oncologist at a tertiary care centre. The EFS was completed by one of the investigators, with the treating oncology team blinded to results and a follow up 14 month chart review. Results: Forty-six patients were enrolled with the following characteristics: average age 76, 48% male, 78% performance status (PS) 0-1, and 21 (46%) started chemotherapy. The EFS was reproducible between visits (r = 0.81 [CI 0.64-0.9, p<0.0001]). There was no correlation between the EFS and receipt of chemotherapy for the study population as a whole. As none of the 16 stage II patients had high-risk features requiring chemotherapy, the analysis was repeated excluding these patients. There was a reduced likelihood of receiving chemotherapy for stage III/IV patients with higher EFS scores (Odds ratio 0.56 [CI 0.37-0.85, p<0.01] per unit increment). A similar effect was observed after multivariable analysis (adjusting for PS, age, stage and gender, Odds ratio 0.41 [CI 0.18-0.96, p<0.05] per unit increment). No correlation existed between EFS and upfront dose reductions, choice of less toxic regimens, or hospitalization secondary to grade 3/4 toxicities. Conclusions: This pilot study suggests the EFS can identify patients that Oncologists may have thought were too frail for chemotherapy, independent of PS. Therefore, the EFS has the potential to add a reproducible, and quantifiable measure of frailty to the clinician’s decision making armamentarium. The next study phase will employ the EFS real-time, and determine if using the EFS can minimize complications and unplanned health care utilization in elderly cancer patients.

Prevalence of scrub typhus in a tertiary care centre in Telangana, south India

2020 ◽  
Author(s):  
Ram Mohan Mylavarapu Venkata Naga Lakshmi ◽  
Teja Vijay Dharma ◽  
Sukanya Sudhaharan ◽  
Subbalaxmi Malladi Venkata Surya ◽  
Rajkiran Emmadi ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Point Of Care ◽  
Tertiary Care ◽  
Delayed Presentation ◽  
Serum Samples ◽  
Tertiary Care Centre ◽  
Doxycycline Treatment ◽  
Clinical Records ◽  
High Index Of Suspicion ◽  
Point Of Care Tests

Background and Objectives: Scrub typhus is re-emerging as an important cause of acute undifferentiated fever in the last decade from various parts of India. Complexity in performing the “gold standard” immunofluorescent assay and the unre- liable nature of Weil Felix test often results in delayed or misdiagnosis in a majority of cases. The present study seeks to integrate the results of rapid diagnostic tests, clinical and laboratory features to aid the diagnosis and management of scrub typhus patients. Materials and Methods: A total of 645 serum samples with suspected scrub typhus sent to the Department of Microbiology were included in the study. Scrub typhus was tested by rapid immunochromatographic test (SD Diagnostics) and IgM ELI- SA (Inbios International, USA). Clinical features, laboratory parameters and final outcome were analysed from the clinical records of positive patients. Results: Scrub typhus was diagnosed in 13.7% of patients and majority of them were observed in the month of August. 58.6% of scrub typhus patients presented with fever of one to two weeks duration. Eschar was documented in 13.7% of patients and 24% of patients gave a history of working outdoors or exposure to vegetation. All the patients responded to Doxycycline treatment and there was no mortality. Conclusion: High index of suspicion for scrub typhus is necessary in febrile patients not responding to conventional anti- biotics especially during outbreak situations. Rapid immunochromatographic tests with excellent specificity and acceptable sensitivity can be used as potential point of care tests for quick diagnosis of scrub typhus especially in delayed presentation.

scholarly journals Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute

2015 ◽  
Vol 2015 ◽  
Author(s):  
Soham Mukherjee ◽  
Anuradha Aggarwal ◽  
Ashu Rastogi ◽  
Anil Bhansali ◽  
Mahesh Prakash ◽  
...  
Keyword(s):  
Conservative Management ◽  
Microvascular Complications ◽  
Tertiary Care ◽  
List Type ◽  
Short Term ◽  
Tertiary Care Centre ◽  
Systemic Manifestations ◽  
Systemic Symptoms ◽  
High Index Of Suspicion ◽  
Learning Points

Summary Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in the last 3 years in a tertiary care centre with simultaneous or sequential involvement of multiple groups of muscles or involvement of uncommon sites. All these patients had advanced duration of diabetes with microvascular complications and poor glycemic control. Conservative management including rest and analgesics is the treatment of choice. Short-term prognosis is good but there may be recurrence. Learning points A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics. Acute–subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI. MRI is the most sensitive test for diagnosis. Muscle biopsy should be reserved for atypical cases. Conservative management including rest and analgesics has good outcome. Improvement usually occurs within 6–8 weeks, but there may be recurrence.

scholarly journals The Association of Various Placental Lesions with Perinatal Outcome in Preterm Births

2021 ◽  
Vol 8 (5) ◽  
pp. 357-364
Author(s):  
Ashwini Sarode ◽  
Anil R Joshi ◽  
Anjali S Kulkarni
Keyword(s):  
Perinatal Mortality ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Vascular Lesions ◽  
Placental Pathology ◽  
Tertiary Care Centre ◽  
Inflammatory Lesions ◽  
Clinical Records

Objective: Present study was designed to identify various lesions in placenta and investigate their impact on neonatal and perinatal outcome and also to determine the frequency of various inflammatory lesions in placenta. Materials and Methods: Placentae of 60 singleton nonanomalous preterm births were examined at Department of pathology at Tertiary care centre. Complete placental examination including both macroscopic and microscopic examination with the help of Haematoxylin and Eosin staining done. Thereafter placental lesions were classified according to Redline criteria for classification of placental pathology. Thereafter placental lesions were correlated with perinatal mortality and neonatal morbidity in early neonatal period. The relevant clinical details were collected from the obstetric clinical records and neonatal clinical records. Result: We found placental vascular processes as most frequent (73.33%) pathological lesion in our study. Most common inflammatory lesion in our study was chorioamnionitis (15%). Also among placentae of stillbirths, placental vascular lesions were predominant finding present in 85.7% of placentae of stillbirths. Other lesions found in placentae of stillbirths were Immune inflammatory lesions, maternal floor infarction and placenta accreta. Out of total placentae with vasculopathy, 19.2% cases developed neonatal sepsis, in chorioamnionitis group 66.6% live births were having sepsis. In present study we observed higher frequency of resuscitation in babies with placentae having chorioamnionitis. Discussion: This study revealed that the placental pathological findings appear to be correlated with perinatal mortality and early neonatal morbidity. So, examination of the preterm placentae gains importance in early determination of morbidity in infants. Placental findings can help neonatologist in routine diagnosis and management. Keywords: Placenta, Placental pathology, Preterm births, Perinatal outcome.

scholarly journals The Prescription of Allopurinol in a Tertiary Care Centre: Appropriate Indications and Dose Adjustment

2012 ◽  
Vol 5 ◽  
pp. CMAMD.S9803 ◽  
Author(s):  
Al-Bishri Jamal ◽  
Al-Harthi Salma ◽  
Al-Sofiani Wafa ◽  
Almutairi Ghadah ◽  
AlOsaimi Roaa
Keyword(s):  
Creatinine Clearance ◽  
Dose Adjustment ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Contributory Factor ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Female Ratio ◽  
Clinical Records

Objective To determine the appropriateness (both indications and adequate dosage regimen via creatinine clearance estimation) of allopurinol by physicians of different specialties in a tertiary care centre. Patients and Methods In this cross sectional study computerized clinical records of 156 adult patients who were prescribed allopurinol from 12th November to 11th December, 2011 were retrieved from Al Hada Hospital Taif Saudi Arabia. Main outcome variables were approprsiate indications of allopurinol, prescribing physician's specialty, and dosage of allopurinol. The prescribed dosages were categorized into correct and incorrect dose adjustments based on creatinine clearance estimation. The SPSS version 16 was utilized for data analyses. Results The mean (±SD) age was 58.15 (±14.99) years. There were 105 (67.3%) males and 51 (32.7%) females with male to female ratio being 2:1. Allopurinol was frequently prescribed by nephrologists and family physicians in this study. Out of 156 patients, 46 (29.5%) patients received allopurinol with appropriate indications. Eighty-five (54.5%) patients were received allopurinol without dose adjustment based on their creatinine clearance estimation; among them, 21 (13.5%) received allopurinol with appropriate indications. Conclusion The inappropriate use of allopurinol (both the indication and prescribed dosage) is still a major problem in a large tertiary care centre. Furthermore, the specialty of physicians is also a contributory factor in this inappropriateness.

scholarly journals Prevalence and outcome of asymptomatic bacteriuria in early pregnancy

2016 ◽  
Vol 6 (1) ◽  
pp. 223 ◽  
Author(s):  
Sreekumary Radha ◽  
Bindu Nambisan ◽  
Nisha Kizhekkepurakkal Prabhakaran ◽  
Shahida Jamal
Keyword(s):  
Urinary Tract ◽  
Gestational Hypertension ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Primary Objective ◽  
Premature Delivery ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Increased Risk ◽  
Adverse Pregnancy

Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of the urinary tract. The primary objective was to find out the prevalence of asymptomatic bacteriuria in pregnancies less than 28 weeks gestation in our hospital and to study the various adverse pregnancy outcomes in the study group.Methods: This was a cross sectional study done over a period of 12 months at this tertiary care centre in Government sector in Trivandrum, Kerala. A sample size was calculated statistically and 400 women with gestational age less than 28 weeks attending the outpatient department were included in this study. A structured proforma, urine microscopy and urine culture and sensitivity were the study tools.Results: Prevalence of asymptomatic bacteriuria in our study population was 8.25%. Commonest pathogen isolated was E.coli in 57.14% cases. Maternal morbidity was higher in women with asymptomatic bacteriuria (24.2%) than those without (12.5%). Fetal morbidity in women with asymptomatic bacteriuria was 24% whereas it was 12.5% in those without it. Preterm labour, preeclampsia and prematurity were the common morbidities noted.Conclusions: Since pregnant women with asymptomatic bacteriuria were at an increased risk of adverse maternal and fetal outcome, routine screening for asymptomatic bacteriuria preferably in the first trimester is highly recommended.

scholarly journals Thoracic empyema: clinical course and management in Trivandrum Medical College

2021 ◽  
Vol 9 (9) ◽  
pp. 2681
Author(s):  
Sony P. S. ◽  
Vinu C. V. ◽  
Suresh Kumar J. ◽  
Kishore Lal
Keyword(s):  
Treatment Guidelines ◽  
Early Recognition ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Tertiary Care Centre ◽  
Obstructive Pulmonary Disease ◽  
Female Ratio ◽  
Thoracic Empyema ◽  
Medical College

Background: The incidence of empyema thoracis among adults is increasing steadily. It may be primary empyema (pleural infection developing without pneumonia) or secondary empyema. The common cause of secondary empyema being- community acquired pneumonia or hospital acquired pneumonia, empyema due to iatrogenic causes, secondary to trauma etc. With advancement in science and technology, early recognition of empyema in patients with symptoms is now possible. But the treatment guidelines are not unified so that each physician may treat this condition in a different way without referring to higher concerned specialties making it complicated. The objective of this study was to determine the clinical profile of thoracic empyema in Trivandrum Medical College a tertiary care centre in South Kerala.Methods: A total of 56 patients with empyema admitted to Government Medical College, Trivandrum, Kerala in 2018-2019 were reviewed retrospectively. The demographic details, clinical presentation, etiology, microbiological findings, and management were recorded in a planned proforma, and analysis was done.Results: The mean age was 49.1 years with peak incidence seen in 40-60 years of age. The male to female ratio was 4.6:1.0 and right pleura was more involved than left pleura. Risk factors were diabetes mellitus, chronic obstructive pulmonary disease, pulmonary tuberculosis, and smoking. Etiology of thoracic empyema was infective in 78.6% cases and traumatic in 21.4% cases. Only two cultures showed gram positive aerobe, rest of the culture was sterile. Only a few cases resolved with medical management. Decortication was needed for 52 patients (82.1%).Conclusions: A unified protocol need to be formulated and followed up in all centres for the management of empyema before its evolution and thus reducing the incidence of empyema and its associated complications. 

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